The
primary emotion Anxious AD {AxAD} children feel is anxiety and their
anxiety usually appears connected to abandonment in some form- e.g.,
parents will leave or reject the child from the family or totally ignore
the AxAD child in favor of a preferred sibling. However, there is a
deeper terror lurking in AxAD children: psychologically, “no one
is home”. They have a terrifying sense of no existence of their
own and a need for attention from others to somehow “confirm”
their existence. Usually, whatever AxAD children are worried about will
be dismissed with indifference. However, they are working very hard,
all the time, to protect themselves from abandonment and from experiencing
their internal sense of “non-existence”.

One
way AxAD children do this is to appear to emotionally relate to others,
and thus, they can exhibit what looks like attachment behaviors. AxAD
children use this apparent closeness as a tranquilizer to quiet and
avoid their own feelings. AxAD children devote their hypervigilance
to determining what others want from them. In the absence of needing
relief from their anxiety, AxAD children can be indifferent to, or rejecting
of, interaction.

The
primary behavioral maneuver AxAD children rely on is superficial charm;
AxAD children are the most skilled of all AD children at presenting
a charming façade. Their behavior varies dramatically depending
upon with whom they’re interacting. They almost always deceive
adults outside the home, particularly teachers, for AxAD children generally
manage themselves quite well at school.

When not motivated to be charming, AxAD children are likely to revert
to whining and complaining about a variety of things. AxAD children
always need to be doing something so that they do not get near to their
terror within. These are the children most likely to incessantly chatter,
ask pointless questions, and make meaningless statements. AxAD children
lie a high percentage of the time and they never acknowledge having
lied. They are proficient at lying about lying. These children work
diligently to “manage” the adults’ liking of them.
Drawing on their superficial charm, AxAD children will present themselves
“as if they are…” to procure the adults liking them.

AxAD
children rarely express thoughts that are truly “their own”.
The demand to be “real” frightens them. They are very skilled
at eliciting clues from the environment; and often ask, “What
do you want me to say?” Answers are then crafted around those
clues. Such answers can sound insightful, but are typically meaningless.
It is easy to underestimate AxAD children’s abilities to evade
real feeling.`

AxAD
children can be very intrusive, conversationally and spatially. While
their intrusive behavior can be quite irritating, it is not motivated
by a wish to create distance; but by the wish to be part of things without
the skills to do so more gracefully. Verbally, this manifests as constantly
interrupting, to the point that they may need to put their hands over
their mouths to control the impulse.

AxAD children are quite skilled at setting others up, particularly siblings
and peers. These children will seek peer friendships, but those friendships
tend to be superficial and with younger children. If asked, AxAD children
will report having numerous friends regardless of the true circumstances.
In adolescence, if prior therapeutic progress has not been made, AxAD
children, and particularly girls, are quite likely to substitute sexual
promiscuity for friendship.

Historically,
most AxAD children lost someone they were attached to early on. They
seek to replicate this experience with subsequent adults. Pressure will
be exerted on parents to remake themselves in the image of the lost
attachment figure, and when parents don’t cooperate; the AxAD
child becomes resentful. This resentment frequently gets expressed by
somehow hurting the parent while being physically affectionate and by
spreading false stories of mistreatment by their parents. AxAD children
are the most skilled, of all AD children, at spinning believable tales
of abuse by their parents.

In
therapy, AxAD children are rarely openly defiant or irritatingly passive-aggressive;
and hence, they can appear to be making progress when, in fact, little
of significance is occurring. They can lapse into tears in an effort
to influence the therapist to not challenge them so much. In terms of
techniques, both EMDR and neurophysiological exercises such as Brain
Gym, can be quite useful.

AVOIDANT ATTACHMENT DISORDER

The
predominant emotion internally, in Avoidant AD {AvAD} children is sadness.
However, the world sees little or none of their sadness. AvAD children
believe their sadness is infinite, and should they lapse into it, they
see no exit. Hence, they go to extraordinary lengths to avoid any expression
of it, and usually effectively shield themselves from even recognizing
their sadness. Their internal shields work so well that they often truly
do not think they are sad. What AvAD children do feel is an anxious
edge in quieter moments. They rarely relax, lest their sadness “creep
up” on them. Their hypervigilance is more about deflecting anything
that might activate their sadness rather than simply scanning for direct
hostile threats. As physical / emotional closeness carries a high potential
for triggering their sadness, AvAD children avoid it. Attitudinally,
AvAD children are contemptuous of sadness- they define it as the “stuff
of sissies”. AvAD children present themselves as omnipotent and
without need for others. About half of these children lie somewhere
along the spectrum of depressive disorders.

The
predominant behavioral strategy utilized by AvAD children is passive-aggressive
behavior. Various behaviors are employed for their nuisance effect in
order to pollute the air with tension, which minimizes chances of their
sadness being awakened. Tasks are commonly done quite slowly to generate
frustration in others, which again buffers any sadness. Promises made
are usually broken for the same reason. The speech of AvAD children
is sprinkled with muttering which is yet another passive-aggressive
variant to create irritation and block sadness. AvAD children do not
engage in incessant chattering, and when they do, that can indicate
that their sadness has been stirred.

Given
their dislike of physical contact, AvAD children stiffen up when touched.
Hugging them is like hugging a board. As touch taps their sadness, AvAD
children, when touched, may well: complain of being hurt or of not feeling
well, insist that the touch is making them itch and they must scratch,
or engage in physically self-abusive behavior, all in an effort to distarct
themselves from any emergent sadness. Attempts to impose physical closeness
when it is not wanted may be met with physical aggression, not as a
direct expression of anger, but as a way to shift the context away from
possibly activating sadness. AvAD children also habitually overreact
to minor cuts or discomforts.

In
terms of treatment, physical holding is frequently necessary with AvAD
children to access their sadness. When the breakthrough comes, AvAD
children can feel suicidal for a period of time. It is useful to remind
them that they were alone initially when they experienced their sadness,
but there are others present to help them now.

AMBIVALENT ATTACHMENT DISORDER

The
leading emotion in children with Ambivalent Attachment Disorder {AmAD}
is anger and rage. These children are openly angry, attitudinally, verbally,
and behaviorally, most of the time. This is the subtype most interested
in fire, gore, and death and least developed in terms of conscience
and values. They are almost wholly incapable of giving or receiving
affection. AmAD children have histories of multiple placements and about
half of them are not living in family environments. About 1/3 of these
children are psychopathic - they understand the impact of their behavior
on others, and they simply are indifferent.

The
behavioral lead card of children with AmAD is direct aggression. These
children are not passive aggressive, but directly oppositional and demanding.
If manipulation does not obtain them what they want, AmAD children will
become aggressive. They are willing to destroy their own and others’
property and to hurt animals and other children. With adults they are
quite likely to be overtly threatening, but the actual use of aggression
depends upon their appraisal of the likelihood they will get hurt. They
are quite comfortable explicitly telling others to get away from them.
AmAD children derive excitement from risk-taking behavior and commonly
do not understand the inherent danger involved.

AmAD
children see scarcity everywhere, and therefore what is wanted should
be taken as it is not going to be given by anyone. Having to hurt someone
to get what is wanted is viewed simply as “the cost of doing business”,
and the other person is seen as deserving being hurt for having been
in the way.

AmAD
children are deliberate academic underachievers, based on the principle
that the lower the expectations, the less you have to do. A good number
of them are placed in LD programs as a result of their chronic underachievement.
Their behavior tends to be equally problematic at home and school, and
AmAD children get suspended as early as preschool.

AmAD
children attempt the use of superficial charm to influence others. However
they are typically quite incompetent at this and come across as transparently,
and unappealingly, manipulative. Their invented tales of abuse at the
hands of their parents are also clumsily crafted and easy to dismiss.

DISORGANIZED ATTACHMENT DISORDER

The
characteristic emotion of children with Disorganized Attachment Disorder
{DAD} is overwhelming and unmanageable anxiety. There is always some
degree of neurological impairment present in DAD, and many of these
children suffered IUE to alcohol and / or drugs. The overwhelming anxiety
leads to significantly disordered thinking and behavior that can mimic
bipolar disorder. Associations can be highly illogical such that no
thread can be followed. Behavior can be bizarre, unpredictable, perseverative,
and wholly unrelated to the situation.

DAD
children are vulnerable to systemic dysregulation. After they recollect
themselves, DAD children can feel some remorse for their behavior. However,
their remorse does not alter their behavior because their behavior is
driven by overwhelming anxiety, which goes unaffected by remorse. Underneath
the disorganization of DAD is another type of AD, which is more observable
when the child is not systemically dysregulated.

The
characteristic behavior of children with DAD is, paradoxically, being
behaviorally disorganized over time. This chronic disorganization leads
to the problematic behaviors frequently shifting, and the relevant adults
feel they are forever chasing new problems. DAD children tend to be
excessively friendly with strangers, but they do so in a syrupy, bizarre
manner that is ineffectual. Children with DAD can look like they are
dissociating, and when they appear this way, they are usually listening
to internal voices. If asked about voices or delusions, DAD children
typically deny both. These voices can communicate very bizarre content,
which can influence behavior and further compound the disorganization.

Due
to their neurological impairment, a high percentage of DAD children
need to be placed on antipsychotic medication which serves as “glue”
for their vulnerable nervous systems.

Acknowledgement is due Elizabeth Randolph Ph.D. for her work on delineating
the subtypes of Attachment Disorder, upon which this article is partially
based.

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